Trauma Tribulation 003

A 27 year-old male was involved in head on collision at high speed.  He was GCS 8 at the scene.

A CT Head was performed:

Trauma Tribulation 003 image 12

Trauma Tribulation 003 image 21

Trauma Tribulation 003 image 3

Questions

List 5 abnormalities on the CT brain.

1.  depressed, comminuted fracture of the left temporal bone

2.  fracture involving the left orbit

3.  scalp haematoma overlying the fractured temporal bone (and you can even see a big laceration)

4. pneumocephalus

5. a small left sided acute subdural haemorrhage

6. a small left frontal intraparenchymal haemorrhage

Anything else?

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About Paul Young

A proud graduate of The Breakfast Club, Paul is an Intensivist in Wellington, New Zealand. According to his father, Paul studied medicine after performing a cost-effectiveness analysis of his own biomedical fragility – a champion runner as a youth, he now struggles with a zimmer frame. Although he started out in the ED, Paul feels physically ill whenever he steps foot there these days.

Comments

  1. Hildy says:

    That left sided bleed looks like an extradural; it is lenticular, at a classical site, and in a young brain.

  2. Ivy says:

    probably le fort III fracture, subcut emphysema right orbit, some subarachnoid blood, cerebral oedema, mild midline shift

  3. doncuan says:

    1. acute subdural (NOT extradural despite the site)
    2. pneumocranium
    3. depressed fracture temporal and would have to look up other -- 4. sphenoid?
    tight base and I think maybe some 5. uncal herniation?
    no midline shift
    not much room in those ventricles but hard to say if effaced on limited slices

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